BABIES DO NOT GROW ON TREES. PLEASE LOVE YOUR CHILDREN.

I was on call in the operating theater (OT) last night.

It was quite an eventful night. Very taxing, both physically and emotionally.

Then, there was this case which was put up at about 4am in the morning.

There was this 4 year old boy, let’s call him XY, 13 kg, with total amputation of the left middle finger and amputation of the tip of the 4^th finger with open fracture of the middle phalanx. Are they going to resuture the finger? – I asked Khalidah. She was not sure either.

The child arrived at the OT. Small and fretful. I could not imagine how mischievous he might have been, to be involved in such accident. He held on to his mother.

Further history from the mother, XY was playing alone when his hand, in her very own words, ‘tersepit kat pintu’. How did it happened?? I blurred, she replied ‘tak tahu lah’. DENIAL. I quickly ran through some short medical and surgical history and examined the child, then pushed him to OR6. (Operating Room 6).

The child was put under general anesthesia and the orthopedic team planned for a refashioning on his fingers, which means, no they were not going to reattach his fingers. This was obvious right from the start – we did not have a hand surgeon in hospital Melaka.

I went through the case notes later, only to discover the hidden agenda. The child was the youngest out of 4 sibling. He was playing alone at home, at the door, when the accident happened. His parents brought him to the hospital only FOUR hours later. The ortho team initially planned to refer and transfer them to Hospital Serdang for reattachment, however, the parents refused for referral because of ‘domestic issues’.

WTF!

I mean it is difficult to salvage a finger which had been amputated for 4 hours, but if you were the mother, and you know that your kid still have a chance to reattached the amputated limb, wouldn’t you go all out??? And they say mother’s love is the greatest love of all… I cannot be too sure. His father wasn’t around for opinions either. Just because you think you can have as many babies as you like, it does not mean you get to neglect them.

BABIES DO NOT GROW ON TREES. 

PLEASE LOVE YOUR CHILDREN.           

It pains my heart so very much when seeing incidents like that. What if the child grew up and wanted to be a surgeon? What if he wanted to be a pianist? Of course, there is prosthesis and all, but why not give him a chance? It is such a sad story….

To add salt to the wound, rub it in, there was another unfortunate case last night, following that case. 10 year old girl, let’s call her XX, came with amputated right ring finger, case put up by orthopeadic team for refashioning of finger. From the history, it was an accident, the child was riding on a bicycle when her finger caught between the wheel and amputated. I feel sorry for the girl. She would never wear her wedding ring perfectly again. It is so sad.

I think I will not like my next houseman posting – orthopeadics. It is a ‘BRUTAL’ department, I think, with lots of amputations which I could not bear to see. Amputation of finger, or fingers, toes, limbs, BKA, AKA, etc…. I wonder how would I ever survive the OT then.

My GA MO, Soon, newly wed last month, apparently, he shared similar opinions, he said disappointedly, ‘I really cannot understand these parents, how could they leave their kids like this’.

I replied, ‘Soon, when you have kids, please take good care of them’

i think parent-ship can be one of the biggest challenges... 

sometimes, i wonder how my parents did it...

they must have been like SUPER MOM and SUPER DAD...

how i missed you...

will be home soon...

(p/s: names and demographic data had been modified to preserve confidentiality)

My first Spinal Anesthesia Experience

‘First give-PUSH, Second give- STOP’

‘First give-PUSH, Second give- STOP’

‘First give-PUSH, Second give- STOP’

The thoughts rolled through my mine, repeatedly, again and again, as I scrubbed my hands. It had been quite a while since I last scrubbed into the OR. My head goes through the process again, picturing myself doing it. Briefly, swiftly. I have seen this many times, I can do it – I tried to deceive myself, or rather, encourage.

The emotion tensed. My MO pat my shoulder, as if giving reassurance.

I am ready.

I have to be.

I put on my surgical gown. Glove size 6 and a half. Latex.

I spread the sterile set, arranging the instruments the way I liked it to be.

With my right hand, I shaked the 0.5% heavy bupivacaine, to-and-fro. Then, break the vial.

I carefully attached the 21G green needle to the 5cc syringe. 2cc was syringed out from the vial.

I added 0.5cc fentanyl, making it a total of 2.5 cc.

In another syringe, I syringed out 2cc of Lignocaine 2% (Local Analgesia).

I folded the the sterile green gauze into triangular shapes , neatly and placed them into a galipod as my assistant poured some disinfectant inside.

I prepared the spinal 25G Pencan needle, putting it through a 21G needle.

Then, I took a deep breath.

It is time.

My patient was seated up on the operating table, with straight back, head looking down, arms hugging a pillow.

‘Encik, doctor nak cuci belakang ya. Sejuk sikit. Cuba relax’ I said, with my awfully broken bahasa, with attempts to comfort the patient.

With a sponge forceps holding the green gauze, I cleaned the procedure site in circular motion. I repeated this procedure again, and then draped the site with a grean cyst towel.

I run my fingers by the sides of the man, trying to feel for the protruding bone (PSIS) and palpating for the intravertebrae space, locating for L4-L5. I marked the area.

‘Doktor nak bagi ubat tahan sakit ya. Sakit sikit macam semut gigit ya. Encik sabar ya.’ I said and injected the local analgesia.

Then I took a deep breathe.

‘Encik relax ya, badan tegak, kepala tunduk bawah. Doktor nak injek ubat ya. Cuba jangan gerak’

I rechecked the marking and space.

With the 21G needle guiding my 25G spinal pencan needle, I inserted the needle into the marked area, towards L4-L5.

I felt a resistance at first, then a give. –THE FIRST GIVE, I reminded myself.

Then, I inserted the spinal needle further, then I felt some resistant, gritty sensation, then another give –THE SECOND GIVE.

YES, this should be it!

I removed the trochar (inner needle).

I felt almost euphoric when I saw what I saw.

Clear CSF flowing out, driping out at the end of it, drop by drop.

Thank you GOD! My heart shouted.

I reconfirmed the flow with a syringe, slowly. Good flow. Then, slowly, I injected the prepared anesthetic solution in.

With a breath, I removed the needle.

The Staff Nurse sprayed the operation site and plastered it with a gauze. ‘Bolehlah jadi MO GA nanti’, she teased me.

The patient was layed flat again.

I monitored the blood pressure, making sure it do not drop drastically.

‘Encik okay tak? Boleh cuba angkat kaki’ I said.

‘Tak bolehlah,' he said. 'Kaki berat’ he replied.

‘Jangan risau, Ini kesan daripada ubat bius. Kalau rasa sakit, beritahu ya’ I said.

The surgeon rechecked with a forcep. –No pain

‘You may proceed’

He made an incision –No Pain.

YES, the spinal worked.

The surgery went well, completed in 49minutes. Patient had good anesthesia. Thank God for that.

I documented – No difficulty during procedure, single attempt, atraumatic tip, clear CSF, good flow.

My MO teased me, ‘There, wasn’t that hard, isn’t it?’

YA RITE! (sarcastically)

THERE – my first spinal.

The satisfaction & feeling – PRICELESS!

Gee, I think I am starting to like GA!! (well, maybe)

----------------------------------------------------------------------------

-For the benefit of Non-medical related fields reader,below are some terms and  abbrevations used in the above article:

OR = Operating Room

MO=Medical Officer

CSF = CerebroSpinalFluid

PSIS =Posterior Superior Illiac Spine (at the level of L4-L5)

L4-L5 = Lumbar spine bone level 4 - 5

heavy bupivaccaine = anesthesia solution

Lignocaine = local analgesia

euphoric = high peak of joy, happiness

-------------------------------------------------------------------------------------------------------

DISCLAIMER: The author will not be responsible if this article or part of this article is used as a guide to one's medical practice. note that this is the author's personal experience and should never be used as a guideline.

ACKNOWLEDGEMENT:

Acknowledgement to Datin, The HOD, for permiting and encouraging House Officers to perform procedures under supervision and provide a good learning environment.

Acknowledgement to Medical Officers & Specialists for teaching us with patience and giving us the opportunity to learn and grow into better doctors.

Acknowledgement to my collegues and other House Officers for helping one another, and encouraging each other as we go through housemanship.

Acknowledgement to the hospital staff, staff nurses, PPKs, for being supportive.

Most importantly, Acknowledgement to patients, for having trust in us.

THANK YOU

My first appendicectomy, skin-to-skin, an awesome experience...

 This picture was from the internet. i did not take any picture intraoperatively.

It was exceptionally quiet today.

Sounds around me seemed clear. Amplified.

I clean, draped, , palpated and made the mark with the forceps. Made a silent prayer.
With the scalpel in the right hand, the Lanz incision was made.

‘Deeper’, he said, ‘Do not be afraid’ he offered words of encouragement.

Inhaling, exhaling, I made a deeper incision into the subcutaneous layer. The incision was deepened with the diathermy. Minor bleeders were 'buzz-ed' with it as well. The subcutaneous layer deepened and retracted apart.

‘Proceed’ he said, ‘Don't worry, I am here, I will assist you’ he continued, holding on to the retractor. The rectus sheath gently cut. External oblique muscles, internal oblique muscles and transverse abdominalis muscle split respectively. The peritoneal layer gently lifted.

I could see the bowels floating below. Very carefully, I felt the thin layer of peritoneum between my fingers, and gently made a nip. The peritoneum breached. Peritoneal fluid clear.

‘Now, look for the culprit’ I whisper to myself.
The small bowel stared at me. ‘No, not you’ my heart seemed to talk. The small intestines pushed aside gently with the swabstick.
Now there you are. The ceacum was smiling at me. I traced my way along the Teania Coli with the Babcock, and finally, the little mischievous appendix was there. No more running away. It was green in color, gangrenous, swollen.

‘See, this is a gangrenous appendix, impending perforation’ he commented.
Wow, I thought. ‘Don’t panic’ he said, reassuring.
‘Remember, the window of opportunity’ he said, guiding me.
‘Yes’ I nodded obediently. The artery was gently pushed through and mesoappendix clamped.
‘You know your hand-knots?’ he asked.
‘Yes’ I replied.
So, I tied them, tight and carefully.
Then the mesoappendix were snipped away from the appendix.

The base of appendix was healthy. It was crushed and clamped. Then, carefully tied. Twice.

‘Finally, the most-awaited moment’ he said, as he hand me the kidney dish with the scalpel inside.
And this is when they called it APPENDICECTOMY. He said, smiling, as I gently cut the appendix. Clean.

Phew.

The incision area was rechecked for bleeders. Dry swabbing done. Hemostasis secured.

Now, the abdomen was closed in layers. I happily sutured them, neatly, layers by layers while he started to unscrub. He remained in the room, still watching from the corner of his eyes. Offered me confidence yet ready to catch me if ever I fall.

Today, I did my first appendicectomy with Dr Mitesh, skin-to-skin.

'Appendicectomy of a gangrenous appendix in 50 minutes, with lessons in between. Not bad for a start,' he said.

And guess what??

It was the most awesome experience in my whole surgical posting and perhaps one of the notable best experience in housemanship.
I think I idolized him. Dr Mitesh.

He was the first person whom i met had the patience to teach housemen to do surgery, step by step.

First teaching, guiding them, then allowing them hands on. He guides you along the way, helps you when you are stuck and teaches you.

For that, I respect you and hope that one day, I will be just like you.

It is my dream that more and more Medical Officers and Specialist would spare some time to teach their housemen.

You know, a teacher’s contribution never ends. It continues to shine in the works of their students.

To him, I may be just another houseman, eager to learn.

For me, this is one of the most awesome moment in my life. A motivation in life. A lesson learnt. and perhaps one day, a life saved. A difference made.

13/05/2010, 1500Hour – 1550Hour, OT6.

P/s: Post operatively, The patient was later reviewed in the ward.

He was discharged well, happy, ambulating and tolerating well orally. Wound clean.

--------------------------------------------------------------------------------------------------

A little history about appendicectomy:

The first successful appendectomy was done in Davenport, Iowa in 1885 by Dr. William West Grant. The patient was Mary Gartside, age 22.

Footnote:

Acute Appendicitis - acute inflammation of the appendix, a life threatening condition. If ruptures, may result in perforation, sepsis and death.

Appendicectomy or Appendectomy - a surgical procedure in which the appendix is removed

p/ss: i've heard of my stories of bomoh removing stones via magical way. Just a thought, somehow they have not figure out a magical way to remove the appendix, have they? haha... obviously, you can't just pick up appendix from the roadside, can you?

Most miserable 2 and a half hours of my life!

(picture by hannusaaski)

I have a terrible toothache. I can feel as if my face is asymmetrically swollen. The pain, intense, that I cannot clench my teeth, or close my mouth. Eating has became a torturous luxury. The regular drugs and cold therapy did not offer much relieve.

This toothache did not come suddenly. I would have to flash back 2 months back.

~2 months ago~

So, on the first week of Medical posting, I had some free time. So, honey and I decided to see the dentist. I wanted to do some scaling. I liked the feeling of my teeth feeling all sparkling white after scaling, you know, with that -‘shing’ *blink* *blink* feel..

Upon arriving at the dentist, a quick examination was done and I was told that I had some tiny holes in my teeth. So, the doctor, she asked whether I would want them filled. Well, the holes were not causing any pain (at all!), but the doctor was very convinced that in a matter of time, it would. Besides, being human, when you were told that there was a problem somewhere and that problem can be fixed, naturally, you say, ‘okay’. So, that was what I did.

The doctor gave me a number and sent me upstairs. I was approached by a cute, sweet girl. She introduced herself as a third year dentistry student. Let’s call her DS (Dental Student). She wanted to take some history, so, I agreed to her. I know how it is like, being a student, I mean,after all, I AM a student. So, we should never reject one of us, right? What I did not know was a dentist had to take such a long history, and a couple of other things. The history included past medical history, past surgical history, allergy history, family history, social history, etc… almost similar to the history that we, medical students take.. only that it was more superficial, and they had an additional: past dental history.

Later on, DS sat me on the couch. The next thing I saw was she, reaching out for the handpiece. Then I was like, *blink* *blink* - OMG! are YOU going to do my fillings for me??? YOU of all people??? NO WAY!! - My heart was screaming aloud: But I thought you were just a 3^rd year.. where are your seniors? where is your supervisor?? Have you practiced on enough fake teeth or models? Shouldn’t your supervisor be supervising you??? What if you introduced a focus of infection or injured some nerves?? I don’t know… millions of thoughts ran through my head, millions, clouding, debating through my mind, so many that I cannot tell them apart, which was true, which wasn’t. But one dominant thought stood out: ‘TRUST THAT GIRL!’ –which 2 months later, I totally regretted…

Actually, it did not take me 2 months to regret. 2 hours later, I was already regretting,.

(picture by kizioko)

DS tied some metal ring around my teeth. Then put a frame around it. She tied a pink sheet of plastic cloth across it, sort of making a tent. I suppose, that was to reduce the risk of infection, by creating a barrier between the saliva, which is rich in organism, and the operating site.

I CURSED THE PERSON WHO INVENTED THIS DARN TECHNIQUE!!! (I mean, we can’t always put the blame on the small girl, can we?) WHO INVENTED THIS TECHNIQUE?? Have you ever, EVER considered the misery of having your mouth opened for 2 and a half long hours, and having your mouth numbed? The saliva all accumulated, stucked at the back of the throat, no suction done… and for asthmatic patient like me, nothing scares me more than the feeling of not being able to breathe, the feeling of overflowing saliva clogging the airway.. how miserable it was….

You can give me statistics of studies, researches on how great it had reduced the risk of infection, blah, blah, blah,… but still, from a consumer’s point of view, this is a stupid, miserable technique!

So yes, I CURSED THE PERSON WHO INVENTED THIS TECHNIQUE!

Guess what? This process was not the worse thing, not yet.. Each time she accidentally touch my gum with that horrifying handpiece, I would wince and let a cry of pain. Okay, maybe I did had a very low threshold for pain, but was I SUPPOSE to feel pain??? Didn’t she just inject some local to numb the pain?? Why the hell was it still painful????

And guess what? Despite the pain, shinyin actually persevered… with this mental thing going on: 5 more minutes, don’t panic… it’ll be over soon.. this is a dream~ you are on a beach~~ breathe in, breathe out~ I tried the relaxation techniques and every possible CBT I read from my psychiatry textbooks.. I would even hypnotize myself if I knew how… ‘sabar’~~

And later on, I heard the scariest vocabulary ever existed in the English Dictionary: ‘OPHS!!’

And DS started stuffing my mouth with gauze and cotton.

I think at this point, I was allowed to panic, because,... she did.

I wanted to ask her whether is everything okay, but you see, my mouth was fixed in such position I could not talk, and I was literally choking on my own saliva, and something which tasted somewhat like blood.

DS disappeared from the cubical and came back with her supervisor.

This was when I started cursing the girl too.

The supervisor took a look at my teeth, shook his head and started lecturing. You should NOT have used that, that, that... You SHOULD have done this, this, this...This ring was of the wrong size and type. You SHOULD have used this, this, this instead. You should NOT have done this tooth first, instead you should have done this, this, this…. And later, he was even quizzing her on what were the consequences of her action.. and there she goes rattling a list of scary possible outcomes, which (touch wood!) I hope would never come true!!

OH MY GOD!! Would you stop scolding your student and come save me???

So, after that session, which seemed like eternity, he taught DS what should she do – ‘remove everything, and close it with a temporary filling’.

–huh? WTF??

So, I was miserably left alone with DS again, to clean up her very own mess… guess what? I get to go home with some pain killers –hooray! She gave me an appointment the week after.

(picture by FvT)

And do you think I would ever be SANE enough to go back?? I mean, if you had just escaped from Hell, and given a follow up one week later, would you go???

So, 2 months later, I suffered from the consequences of defaulting follow up.

Awww…. How my tooth hurts badly…

p/s: Bernard, you junior can be my worst nightmare!

The Baby

I performed a post-mortem today. He was an unwanted baby left by the streets.
Name : Unknown (Let’s just call him, Baby)
Age : Unknown
Race : Unknown
Parents : Unknown
Body found: 03/07/2008 0610
Autopsy on: 04/07/2008 0935
The umbilical cord and placental was still attached to Baby, when I saw him on the forensic table. The forensic room was unusually cold today. The layers of clothing wrapped around me did no help at all. I felt that the world was too cruel,.. how could anyone just abandon a baby on the street! With placental attached and cord unclamped… theorically, either the baby had died in-utero, or he was left to die by the streets…

We proceeded with forensic investigations. Baby was inspected for any injuries. His eyes were dark, staring back melancholy. His expression was stiff. He had a crooked jaw, and excessive caput and moulding. For the benefit of non-medical students, if the baby had caput(swelling at the head) or moulding (overlapping skull bones), this indicate that this baby was delivered SVD (spontaneous vertex delivery, head out first) and not a breech delivery. There were no injuries at the buttocks.

Sex: Boy
Weight: 2.20kg

Then, we investigated the age of the baby. We concluded that he was a term baby evidenced by:
1. Creases on the hands and feet
2. Body hair measuring 10mm
3. Testes palpable in the scrotum (already descended)
4. Dark meconium passed out (passed motion)
5. When cut across the calcaneum (one of the bones at the heel), from the 3rd toe towards the middle of the heel, we could appreciate secondary ossification center of the bones (bone maturation). Secondary ossification takes place at the 8th months, therefore Baby was at least 8 month old(40weeks), term.

Measurements of Baby’s parameter were corresponding to a term baby. Placental 14cm x 17cm x 2.5cm, complete, with blood clots.

The brain was removed, weight and sliced. The brains did not appear hypoxic.

Later, we continued by autopsying the lungs, liver, spleen, heart and kidneys to look for any other pathological injury or disease. A suspension test was done: Baby’s lung was squeeze flat and put into a bowl of water. We found that the lungs floated on the water, which translates to -> there was air in Baby’s lung -> Baby breath first, then die -> this was a livebirth -> baby was delivered SVD and left dying…

Sigh, the world is a cruel world… I could not imagine any mother in this world who could have left a crying baby to die. Before this, I had witnessed many mothers in the labour room who would do ANYTHING to save their baby… different maneuvers, pushing as hard as possible, enduring the pain… But this mother, I really could not comprehend..

A teenage mother came across my mind. Perhaps she was young, confused and did not know what to do with the baby. Prof Adeeb said: Guys only know how to make the girl pregnant. But I suppose the father of Baby did not even know the existence of Baby.

Girls out there, for God’s sake, if you EVER had premarital sex, please use contraception. Condom not only protects you from pregnancies, it also protects you from STDs (Sexually Transmitted Diseases) and HIV.

And IF you missed that contraception, options are MORNING-AFTER-PILLS within 72hours after sex. The eithical issue in this was if morning-after pills became widely available through pharmacies, unscrupulous men could exploit vulnerable young women by saying: "you can always go to the chemist and get the morning-after pill." Do see a doctor to check health status and medical history for anything which might make taking such pills dangerous.

And IF you missed your period that month, please do a pregnancy test.

And IF the test was positive, please discuss with your partner or your family, whether should you continue with the pregnancy and raise the baby.

IF you plan to keep the baby, please ensure that you can mentally and financially support the baby. Raising a baby is not easy. If you are not capable of it, you can discuss with the social worker to give the baby up for adoption, either to a family member or by others.

AND PLEASE SEE A DOCTOR EARLY FOR BOOKING AND ANTENATAL SCREENING.

The first visit is the most important visit, where antenatal screening will be done (eg: Height, Weight, Blood Pressure, Hemoglobin level, Blood Grouping, VDRL/HIV/Hepatitis B Screening, Urine analysis). Any disease eg: Anemia, Diabetes Melitus, Hypertension, if detected early can be controlled and managed to optimize both mother and fetal throughout pregnancy and for delivery. An early dating scan (pelvic ultrasound scan) is very important before 20 weeks to know the age of the baby, the right time to deliver and to detect nuchal translucency (suggestive of down syndrome).

The risk of keeping the pregnancy to term without antenatal screening and follow up is increase morbidity and mortality to BOTH fetal and mother. And attempting to deliver a baby on your own is certainly VERY UNSMART! It’s not easy to deliver a baby and the pain is terrible (without analgesia). GO TO THE NEAREST HOSPITAL. Why else do you think medical student had to study 5years and midwifes 4years to understand that? YOU AND YOUR BABY COULD DIE

IF you wish to terminate the pregnancy, please go to a clinic and seek professional medical advice. Some might argue that a TOP (Termination Of Pregnancy) is unethical, but compared to bringing a baby to term and living it to die by the streets, I shall leave it for you to decide. According to WHO (World Health Organization), any pregnancy below 22 weeks is not yet a viable fetal. Religious and cultural beliefs may have a different opinions. The process of TOP, I shall leave it to another blog entry… I guess I should pen off here, this had been a long entry. Glad you made it to this line! :)

I hoped for a better world, still hoping…



Related links:
My 1st Forensic Experience

COA MALAYSIAN MS - Here In My Home

dear all, i would like to share something very Malaysian today.

i remembered the time, i went overseas for a vacation or for conferences, ohhh.. how i missed MALAYSIA... the people, the food, even the weather!! when you are frezzing cold, wrapped up in rolls of clothing till you're round, degrees -5... how you'll miss the sun in Malaysia... and when you have had enough Kim Chi to last you a life time,.. all i could think of was satay, roti canai and nasi lemak!! my friends from abroad was very impressed that we could speak many languages and dialects fluently... my Hong Kong friend was commenting : They can speak cantonese to me, speak hokkien (similar to Tai Yu) to the Taiwanese, speak Mandarin to the China people, speak English at presentation, and suddenly speak Malay to the Indonesian, and they all sound TOTALLY different!! haha!

and yeah, i am glad to be a Malaysian, this is after all, home~

Here's a songtrack sung my Malaysian Artistes for Unity... it's a very nice song~ great job to Pete Teo and the crew! gee, i love this song!!



check out the making of this video clip at :

hidden cliffs

When being ripped away, the last edge of the cliff, the voice dampens between the vocal cords, you turn into a room deprived of light, the walls closing in, the air growing denser, the darkness engulfing, you lost your very last breath, the very last purpose disappears, flushed away in the black hole… Handicapped you were, regrets you hold, in a world which shows no mercy, shadows haunting you, reminders of the past tattooed on you, and you reject every effort to comprehend, simply because it is too painful to bear, no analgesia or anesthesthetist can numb the feelings, the scar remains, a locked soul, trapped and lost...

         -shinyin 2008-

(Written on February 21, 2008 at 05:25 AM)

COAMS #39 - The first delivery conducted

OS FULLY!!! Dr Yuli shouted while I stared at my index and middle fingers, still trying to figure out whether they were 10 cm apart.

The mother had been suffering over 8 hours of intense labour pain, with contractions pain as often as 5 in every 10 minutes. Imagine having terrible menstrual pain, once every 2 minutes, and multiply the intensity 10 times. Or perhaps a toothache or an awful stomach ache, intensity multiplied 20 times. Labour pain has long been agreed upon to be the worst pain on Earth. Women admired for the strength to endure it.

Bringing water, readjusting the bed, offering the extra pillow, holding the mother’s hand and reassuring her- these had been the medical student’s role here at the labour room in HUKM. Ermmm.., I would not want to leave you with the impression that we have limited ‘function’. I mean, apart from that, students also set the IV line, apply the CTG monitors, run the pitocin, fill up partographs, catheterize patients, etc… but patients often remembers the former.

The calm labour room quickly evolved to a battlefield, as if getting ready for a war. The mother shouting in pain, and everyone else moving swiftly, taking their positions. I grabbed the apron and put on the sterile gloves. People around me were dressed, prepared, and readied. The delivery set opened, sterile drape spread out. She was in lithotomy position, hips and knees bend, both hands grabbing her respective legs. The suction device heard at the background, readied to welcome the baby. I tried to calm the patient, tried harder to calm myself.

The baby’s head appeared at the vaginal opening, as the mother pushed with all her might. ‘TERAN!!’ we shouted in unison, the doctor, the midwives, the students, all very supportive, like a cheerleading team at a ball game. The mother working very hard, doing a very good job, probably she had learnt very much from her previous experiences.

I held the baby’s head while Dr Yuli said, ‘It’s exactly what I taught you in class, stay calm, you can do it’. I was numbed. My hands moved automatically, very obedient to her verbal instructions. The baby squeezed through the passage faster than I expected. A series of pictures flashed through my head. The tension eased, the baby slid out. I clamped the umbilical cord and cut it. The baby cried. I let out a sigh of relief. I was stunned.

The world is a beautiful world.

‘Show it to the mother’ a voice instructed, breaking my thoughts.
Right. I held the baby in front of the mother.
‘Lelaki atau perempuan?’ Dr Yuli asked the mother on my behalf.
‘Perempuan’ she answered, almost breathless.
‘Congratulations!’ I said excitedly.
‘Thank you everyone’, she replied with a smile.

The midwife cleaned the baby and wrapped her in warm sheets.

‘Your first time?’ the Doctor asked.
Yes, I replied. I wondered when she started realizing it.
Congratulations, she said. Thanks Doctor, I replied.

Blood was taken. Lower abdomen massaged, placental delivered and checked. My heart sang happily, as I cleaned up the mess, helped the mother to change and tried to make her as comfortable as possible.

It was a full term 2.54kg baby girl delivered via spontaneous vertex delivery after 12 minutes in second stage. Baby’s Apgar scores were 9/10. Placental and membranes were completely delivered and they weight 600mg. Cord pH was 7.306. Estimated blood loss was 200cc.

I conducted my first delivery that day.

Her name was Aifa Amira.I brought life to Earth.

Correction: God created life. The parents bought life to Earth. The team and I merely facilitate. But it felt so good. Delivery of a child is a magical experience. And I was glad Dr Yuli was so nice, and even more glad that it was a successful delivery.

I called my mum that day and shared with her my experience. I never felt so thankful and appreciative of the pain she went through. She agreed with the rest of the world that labour pain was the worst pain on Earth. She added that I was a very stubborn baby, (still very stubborn now). They had to forcep me out. Okay, let’s not imagine how I might have looked during the first few days of my life.

And if you are wondering whether I will ever put myself through that extreme labour pain,…. Considering my low threshold for pain – N-E-V-E-R!! Well,…….. there’s always epidural… many thanks to the genius who created such great pain relief drugs!!

Footnotes:
CTG = cardiotocograph, a electronic device to monitor fetal well being by measuring the fetal’s heart rate and maternal’s uterine contractions, plotted against time.
Pitocin= a drug used to stimulate the contraction of smooth muscle of the uterus during labour
Apgar score = A scoring scheme to assess the general physical condition of a newborn infant based on a rating of 0, 1, or 2 for five criteria: heart rate, respiration, muscle tone, skin color, and response to stimuli.
Lelaki = Boy (in Malay Language)
Perempuan= Girl (in Malay Language)
(Written on December 09, 2007 at 02:12 PM)

COAMS #38 - My first post-mortem forensic experience...

The Professor made us went down, One by one, we stood in a line, ‘warm’ he said, smiling at me, as if reading the fear written all over my face, as he took my hand and held it longer against it. I guess pretending to touch it didn’t work, and I totally lacked the enthusiasm my coursemates had, and the fear, I wasn’t faking it. I was so obsessed and compulsive, I washed my hands over 10 times that day…

The Professor took a knife and made an incision across the scalp. Then, he pulled the skin outwards and downwards, until the skin of the forehead touches the nose, like peeling a coconut husk. The mini electronic saw made an eerie ‘eeeeee…’ sound as it cut through the skull. The skull pulled apart, the brain removed. ‘No hemorrhages’ my friend whispered, but I was so shocked to actually rationalize anything, anything…

My friend, reading my fear, warned me, this part is even worse, she said, ‘the chest would open like a pod, and every internal organ removed’…The Professor, ignoring my fear, continue his carpentry work through the ribcage. I appreciated the emotional preparation, but somehow, I was still stunned.

Come on, you have seen numerous of cadavers(corpse) before at anatomy dissection, my inner voice tried to rationalize,.. ‘but this is fresh, it’s less than 4 hours!’ another voice argued.. and I wondered whether they were just thoughts or hallucinations…

‘Pop’, the chest cracked open and the mini saw stopped. In silence, he went through the intestines, as if searching for something. He tied one end of the gut, and later extract the whole gastrointestinal tract, from the tongue all the way to the colon, the lungs, the heart, the liver as well.

Then, they moved to another table. The brain was inspected and weight. Then the cerebellum divorced from the cerebrum. He sliced through the cerebellum. ‘Ouch!’ I shouted inside me… Although I understood well that the central nervous system has no nocicepters (pain receptors), and on top of that, it is already dead, I just couldn’t help feeling the pain… Then he sliced the cerebrum(forebrain), 1.5-2.0cm apart, sharply, skillfully and steadily,… spreading each out for signs of stroke, hemorrhages or infections. ‘Clean’, he said. At this point, I have a sense of déjà vu, as if this was a scene from a horror movie,.. I was already peeping through the narrow slits of my eyes.

Later, he started weighting the other organs, one by one, slicing them, analyzing them, like as if it’s the most interesting thing to do in the world – The tongue, the lung, the heart, the liver, etc..

He commented, ‘You should get used to the smell, no covering your nose and mouth with your hands’. He looked up at me, followed by another 30 pairs of eyes (of which belonged to my coursemates). I swallowed a gulp, it regurgitated back. It wasn’t just the smell, this, this was entirely gross… yet, I could tell no one… I cannot imagine me being on the table, and I vowed never to let it happen, and was already making plans to clearly state it in my will… I guess I was shallow, despite my profession background. But hey, I bet you would have thought the same back then if you were in my shoes.

Then, they sew up the body, halfway up the chest, shoved everything back into the body, including the brain and sew it tight. The head was filled with cotton and sutured.

And I, I could not eat any meat that day.

--------------------------------------------------------------------------------

I stared down from above. A group of curious students looked at me, with cruel glances and disapproving expressions. I was not sure whether this should be done, I am not capable of stopping them anyway; I just had to get through with it.

The doctor recorded the bruise marks on my body, the cigarette marks and the multiple old scars from the slashing of my father’s belt.

I was hurt before. And so, I fled to Malaysia for employment, or rather, for new hopes, for a better future. My new employee was very nice to me. Despite not having any blood relationship, they treated me like a relative. I taught their children to read, played, and raised them as if they were my siblings… Here, I found home.

Then one day, my chest hurt so much, I could not breathe… and that was the last thing I could remember.

I feel guilty having my employees now being suspected for abusing me, for my death. How can I tell them, they were kinder to me than my very own flesh and blood? Would anyone believe it?

The doctor sliced through me. Funny, I felt no pain at all. Yet, I felt like I have lost something. That is me, or rather, that was me… Seeing this only restrengthen the fact that I can never return to it. So, that’s it, that’s the end.

As he sliced through the heart, he nods affirmatively, as if he found eureka. ‘Fibrosis- the scar tissue’, he explained to the students, ‘Look, the left ventricular wall is much thicker than the right, left ventricular hypertrophy’. The students nodded in unison while I understood nothing at all. ‘Here, another strip of fibrose tissue’ he continued speaking Latin and pointed to some grayish-white section of my heart. ‘The cardiac enzyme stain confirmed it. She had a heart attack’

I had a heart attack.

Finally, that answered everything. I died from a heart attack, like my mother, which left me to my cruel abusive father. My employees were free of charges.

And I, I was free too…



(Note: all identities are confidential)

Written on September 02, 2007 at 12:51 PM

COAMS #35 - A World without light, colors, dimensions... Are we too blind to care for the blind?

( pic: the picture on the right is the mould while the picture on the left is the embossed tactile diagram of the inner structure of a car. This is found in the form 4 physic textbook)

What is a world without light? An empty world without colors? A world without dimensions?

Last week, I visited the MAB, Malaysia Association of the Blind at Jalan Tun Sambanthan.

It is amazing how much the visually disabled can do. Braille is not an easy language to be learnt. I tried closing my eyes and reading with my fingers, and hell, it was tough… The dotted characters seemed the same, more like tiny sands. Kar Yuen, the 6-year-old kid I met there, was able to tactilely read all the alphabets and numbers as fast as I read with my eyes. Braille is based on only 6 dots, yet it is possible to emboss characters A-Z, 0-9, in codes to be read by touch. Reading Braille is difficult let alone typing it. The Brailler (a Braille typewriter) has only 9 keys. Nevertheless, I had my name embossed in Braille ^_^ (just in case you were wondering, no, I did not typed it, too challenging for me, hehe..)

What impressed me most is that MAB transcribes text print to Braille. Text from novels, to Reader Digest and even school textbooks! An average Reader Digest book, after transcription, would be 3 books thick, each about the size of a box file! With that, the blind or low vision students are able to attend school, both primary and secondary school, together with other ordinary students. Yes, they would be able to sit for UPSR, PMR, SPM, etc… Diagrams (as above) are embossed so that they too can learn. Embossing diagrams is a very tedious task. Reading it is equally difficult. Yet, these special people have a great sense of touch and imaginations, putting together the puzzles into a picture. Really, really impressive.

And there was this guy playing Pachabel Canon in D. He had a diploma in piano. And to think that passing piano exams was a struggle even for people with good vision. Well, at least I struggled, and hell, I don’t even have a diploma! And there was this girl who passed her SPM with flying colors and was awarded ‘Anugerah pelajar istimewa cemerlang’ by the Melacca government. She aspires to be a teacher however her application to a teaching school has been rejected. The world today is too blind to see how much these less fortunate people need our support.

Lastly, I suppose we should count our blessings… (yeah, all of you who are lucky enough to be able to read this)… sometimes, we don’t realize how lucky we are, having one of the God’s greatest gifts. Ophthalmology is a very important branch of medicine, aiming to prevent visual loss and blindness. MAB on the other hand, helps people to cope with visual loss. Education and rehabilation is important...

Can we make a difference? Certainly! It can be as simple as helping a blind people to cross the street or to find a shop. Let him hold your arm and walk slightly in front of them, not behind. If you are helping a blind into a car, tell him which way it is facing, and place his hand on the car roof over the open door. If you are eating with a blind, take the courtesy to tell them what food is served. Debone the fish, if any and never fill up drinks up to the brim to avoid spillage. If you are working, you may pledge to donate a portion of your monthly salary or even provide employment to the blind. Don’t be surprised that the blind is capable to use the computer. They have ‘talking computers’ and manage with hotkeys. They use windows and other special software. Visit www.mab.org.my for more information.

(Written on June 09, 2007 at 09:05 AM)

Masks...

The apple hanged on the tree
In the Garden on Eve
It looked sweet, I thought…
I could not resist
I dreamt of it day and night
If only I could reach.
I waited for the day
A gush of wind would come
And gravity would play its role
Sunsets replaced sunrise,
The day never arrive.
One fine day,
The wind finally came
Then I realized
The apple wears a mask

COAMS #7- Visit to the Leprosy Centre

(November 27, 2005, Sunday, at 18:37)

I find it easier to blog than to express myself verbally. Today, I went to Rumah Harmoni, Kuala Kubu Bharu. It is a spastic home, about two hours bus ride from my campus. What I saw there was nothing like what I had expected…

The place was rather damp, with a foul-smelling odour. Beds were arranged in two rows, facing each other. The beds looked like enlarged metal cradles. In each of these ‘cradles’ was a child, a teen or an adult. I thought that is was almost cruel to put those people behind bars. Perhaps it was worse than staying in prison as they are confined to a 6 X 4 feet bed, where there, they eat, shit and play. Little did I know, they not only have difficulty in speech and movement, they also have mental disorders, almost like big babies who never grew up.
But that was not the worst thing. Some of the kids had their feet and arms tied to the corners of the bed, which was very scary. I realize this is done to protect them, to prevent them from injuring themselves or eating their diapers. Others, being physically disabled and paralysed, all they could do is stare at the ceiling all day.
There was one kid that really caught my attention. The kid had encephalitis. He’s head was huge, almost like the size of an oval-shape watermelon. His body was thin, cachectic, almost the same size as his head. When I was cutting his fingernails, I notice that the nails are long, soft, thickened and brittle. Its structure differs from ours that are collagenously hard. The poor kid couldn’t lift his head. He just stared back blankly.
In another isolated ward, the inhabitants here didn’t even have the luxury of a mattress. They had to sleep on hard icy metal cradles. According to the nurse, they have to tendency to eat the mattress. They weren’t even given diapers. So, the cleaners would clean the beds by just splashing water on them. Imagine how cold that is!
I tried to communicate with the people there. This, was the toughest part. They couldn’t express themselves and I wasn’t sure whether they understood me. Some managed to mumble a few words slowly; some replied in smiles, others just stared back. Later on, we found out that they actually loved music and dancing. So, we find ourselves laughing, singing and dancing with them. Perhaps this is one of those cases where - actions speak louder than words.
There was an aunty who happily added my bracelet to her collection. Yeah, I treasured that bracelet a lot, but to see her smiling, I guess it was worthwhile. If only we could be easily contented and rediscover with our innocence.
At the end of the day, I felt that I was not really to leave yet. Sure, I’ll go back to my everyday life, complaining about practically everything. Then, in time, I might even forget about what happened today. Therefore, I shall blog this down, to make sure I don’t.

I felt sad, I felt empathy for them, and above all, I felt hopeless.

So, I lived in a cruel world. I asked God, why do you allow this? Why can’t everyone be healthy? Then negative questions like, where are their friends? Where are their families? Do they even have families?
There are many people out there, lonely and in need. Yet, very often, we couldn’t find the time to lend a hand. Some of my friends, who initially planned to join us on this service, changed their minds to watch Jolin Chai in person. Some were busy preparing for minitest this week. Some were just too lazy to get up… I wouldn’t brag about myself, because, if Lee Hom was in KL this morning, I would probably not be writing this now. Then again, we, being luckier, should be thankful of what we have. We, being luckier, should help the less fortunate, making them feel cared, loved, ‘belonged’.

--------------------------------
Review on 2008:
reading back this post after 3 years, brings back all the old memories and feelings... the kid, by the way, had hydrocephalus..

COAMS #6 - The CULTURAL SHOCK at Medical School

(November 12, 2005 at 11:52 AM )

Did I talked about the first time I entered medical school, I thought that EVERYONE HERE WAS MAD??? I cried on the first day of university. Yeah, hate to admit that. Laugh at me and I’ll delete this. I had been away from home for camps, visits, vacations, yet this was the first time I felt home-sick. And I didn’t know who to complain to, everyone was encouraging and perhaps more excited than me. So, I started writing my diary. Somehow, writing helps me think, writing calms and soothes the emotion.

To me, coming to university was a ‘culture shock’. The biggest obstacles, okay, maybe I should put it this way, MY biggest problem was - the language barrier. Noone told me that ALL Chinese in university communicate in Mandarin. Well, it’s not that I totally don’t know Mandarin, but it’s just that I didn’t thought I could survive Mandarin ALL DAY LONG. Of course the Malays talk in BM but there were only a handful of Indians. So, well, it’s just BM and Mandarin. Hmm… Welcome to the -WE-DON’T-SPEAK-ENGLISH- world. I don’t know how well I hid my hatred towards this place at that time. I did consider pretending that I don’t know Chinese or joining the Christian Fellowship (which is pointless as the Christians here uses Mandarin as well).‘Why must I adapt to them? Why couldn’t they adapt to me?’ I thought.

I remembered clearly, a senior paused and asked, ’Who doesn’t understand Mandarin here?’. Thankful, I raised my hand only to hear the reply ‘you can get your friend next to you to translate’. I really couldn’t blame him because there was like only 5 hands up and majority rules. But of course, at that time, I was disappointed and it only made me hated this place more. I made a point to try speaking in English to the juniors only to find that most of them were more comfortable with Mandarin. I wanted to help people like me, yet little did I know, I was simply torturing others, so I switched back to Mandarin.

I realised how naïve I used to be. Later, I found out from my friends that it wasn’t just UKM, the same condition is present in USM, UPM, UM… u name it. They complaint and recovered, I remained stubborn, refusing to adapt, until months later… Well, I should consider myself lucky that I didn’t have to communicate with my Chinese roommates in BM (like my friend, Boon Lee). I did wonder though what happened to all those people like me- the Georgians, Paulians, Convent Girls and ACS. They simply vanished into thin air and I had my entire life history wiped out. OK, they went to collages and only a handful studied form6. Oh well….

I’m OK with Mandarin now. In fact, sometimes I subconsciously speak Mandarin even to the Malays, which was kind of embarrassing.

Being already depressed during first semester, discovering that ALL MY COURSEMATES ARE MAD only make things worse. MAD as referring to the way they study -MAD. It was kind of scary, I have to admit. Some can just study for hours, like some machine programmed to work. Of course, at that time I didn’t realised that some people genuinely enjoy studying. And I really envy those people - people who possess the PASSION to be a doctor. What separates me from them, besides the language barrier is that PASSION.

Like I said before, DOCTOR to me at the beginning, was just a profession, interesting, secure, challenging and a little ‘cool.’ Well, if you can’t decide what course to take, might as well take something that would help the people. Hoping that the ‘satisfaction’ will drive me, I took the back seat.

Being welcomed by lecturers who made us felt that medicine is a nightmare itself was a nightmare. Medicine is a lifetime sacrifice, they said. I started to deceive myself that I’ll learn to like this course, like the way I was deceived by TV series that doctors in white coats are cool; and perhaps by Dominic, this UM medical student who gave us such a motivating speech during form6. Nevertheless, I forgotten that for those PASSIONATE ones, it was a whole different story. And no, I did not get to keep the eye from the dissection hall.

Later on, I realised that I’m not alone. Many of my course mates didn’t have this PASSION. Some wanted to be pharmacists, veterinarians, one of them wanted to be a pianist, another a ballet dancer. If I was bold enough to follow my dreams, I would probably be studying journalism instead. But, hey, I’m no Robert Frost. The Tertiary Education Ministry Board would probably commit suicide once they find out how many of us didn’t really wanted to study medicine THAT badly. I did felt a little guilty for those who wanted this place more than I do but did not get it. But of course there were those who REALLY wanted to be doctors. Yeah, I envied them.

Honestly, medicine is not such a bad course after all. Perhaps it was the way I hated UKM when I first arrived, the ‘cultural shock’ that made me bias towards the course. Everything was fine except for the exam part. Simply because I naturally hate exams (who doesn’t anyway? I blame our exam-oriented educational system).

I enjoyed the dissection sessions we had for anatomy, one of the few things I often looked forward to. I loved PBL (Problem-Based-Learning) sessions where we were given medical cases to solve, they made more sense to what we learnt in lectures. The Basic Clinical Skills were fun too, though we had like only 2 sessions. And I loved the anatomy tutorials. And I hated all the tests, regardless mini test or exams- all of them! Lectures? Some are interesting, some were just merely reading from the text, sometimes I wonder-hey, maybe I’ll take his job-. But no, I don’t sleep in lecture halls. I either pay attention or skip them.

Perhaps it is unfair to put the blame on TV, parents and friends. The year I had my STPM, Grandma had a fall. She could barely walk back then and had to use a wheelchair. My uncle and cousin tried traditional medicine, messaging oilments, bandaging herbs. My cousin, Kian Guan happens to be studying Chinese Medicine. It’s not that I don’t trust traditional healers, it’s just that we tried everything, even acupunctures, but the condition did not improve. I felt helpless. Finally, we brought Granny to the hospital, she had her femur fractured and had a minor surgery. I don’t know how she endured the pain. Granny is now on walkers but things were never quite the same. She lost the freedom of walking freely.

Let’s put it this way- yes, I’ve the interest, but not the passion, not yet I suppose. Hey, I have 3 years till I graduate. Perhaps time will tell.